Cognitive performance is impaired in coeliac patients on gluten free diet: a case-control study in patients older than 65 years of age.

INTRODUCTION: Retrospective studies and case reports suggest an association between coeliac disease and impaired cognitive function. AIM: To evaluate functional and cognitive performances in coeliac disease vs. control patients older than 65 years.
METHOD: Eighteen coeliac disease patients (75±4 years, group A) on gluten free diet since 5.5±3 years and 18 age-sex matched controls (76±4 years, group B) were studied using a battery of neuropsychological tests. Results of functional and cognitive tests are expressed as "row scores" and as "equivalent scores" by relating "raw scores" to reference rank categories.
RESULTS: Barthel Index of functional performance was similar in the 2 groups. "Raw score" was significantly lower in coeliac disease than controls for Mini Mental Test Examination (p=0.02), Trail Making Test (p=0.001), Semantic Fluency (p=0.03), Digit Symbol Test (p=0.007), Ideo-motor apraxia (p<0.001) and Bucco-facial apraxia (p<0.002). "Equivalent score" was also lower in coeliac disease than controls for Semantic memory (p<0.01) and for Ideo-motor apraxia (p=0.007).
CONCLUSION: Cognitive performance is worse in elderly coeliac disease than control patients, despite prolonged gluten avoidance in coeliacs. Awareness on the increasing phenomenon of late-onset coeliac disease is important to minimize diagnostic delay and prolonged exposure to gluten that may adversely and irreversibly affect cognitive function.